Key Performance Indicators in Field Hospital Appraisal: A Systematic Review

Background: Field hospitals are health care institutions with mobile or fixed structures. Although there have been numerous models and indicators for assessing the performance of public hospitals, there is no model to evaluate the performance of field hospitals. Objectives: This study was aimed at determining key performance indicators in field hospital appraisal. Methods: In this study, we conducted a systematic review of publications in English or Persian language indexed by PubMed, Scopus, Emerald, Elsevier, Ovid, Google Scholar, Springer, ProQuest, WHO and Word Bank databases. PICO strategy was used for searching databases. Quality assessment of the publications were carried out using CASP checklist. Similarly, the preferred reporting items for PRISMA checklist were used to assess systematic reviews. The PRISMA checklist was used to guide the reporting of the systematic review. A descriptive summary with data tables was produced to summarize the literature. Following the results of our search, 592 publications were retrieved and 352 citations were excluded because of irrelevance or duplication. After excluding the duplicate and irrelevant items we screened 240 titles and abstracts. Two independent reviewers evaluated 240 potentially relevant studies, and 15 records met the criteria to be included in this review. Results: We found 13 criteria on the assessment of field hospital in the literature. We classified all the retrieved indicators according to the system approach. The results of this study showed that input indicators included 4 indicators, process indicators included 2 indicators, output indicators consisted of 4 indicators and outcome indicators involved 3 indicators. Conclusions: This study highlights the most important performance measurement indicators in field hospitals with a system approach. There was no model to assess the field hospitals; however, a systematic approach in assessment can improve the quality of services

Substance Abuse and its Associated Factors among Pregnant Women: A Cross-Sectional Study in the Southeast of Iran

Background: The data on the prevalence of substance abuse in Iranian pregnant women is scarce in the current literature. This study investigated the prevalence of and the factors associated with substance abuse among pregnant women, and compared self-reported use with urine test results. Methods: This cross-sectional study included data for 2000 pregnant women admitted to a tertiary care hospital in the southeast of Iran. Data were collected on socio-demographic characteristics and the patterns of substance use. Multivariate logistic regression analysis was used to identify factors associated with opiate use. A subsample (200 women) was randomly selected to provide urine samples for toxicological screening. Findings: The lifetime prevalence of substance abuse and tobacco smoking was 15% and 31%, respectively. Overall, 3.3% of the participants reported using at least one substance during the previous month. One third of pregnant women reported using substances as a home remedy for treatment of pregnancy related health problems. Overall, 23% of the urine screening tests were positive. The agreement between self-reported substance abuse and the results of the urine tests was poor. Factors associated with opiates use in pregnant women were age at the first pregnancy of less than 20 years, living in rural areas, unwanted pregnancy, lack of healthcare during pregnancy, and having a spouse and/or first-degree family member with substance abuse. Conclusion: This study showed a high prevalence of substance abuse among the studied women. Thus, a multidisciplinary approach to provide preventive educational programs during pregnancy, and interviews and urinary screening of all pregnant women is recommended

Evaluation of antibiotic resistance and CTX-M gene in ESBL-producing Escherichia coli by PCR among urine samples of patients reffering to Yahyanejad hospital of Babol city, Iran

Background and Objectives: Escherichia coli (E.coli) is one of the most common bacteria causing urinary tract infections which has become resistant to beta-lactam antibiotics due to the acquisition of plasmids encoding extended-spectrum beta-lactamases (ESBL). Here, we investigated the phenotype and genotype of Cefotaxsim-M (CTX-M) gene among ESBL-producing Escherichia coli among urine samples of patients reffering to Yahyanejad hospital of Babol city. Methods: The present cross-sectional study was conducted among all 1842 patients referring to Yahyanejad hospital since June to December of 2015. Disc diffusion method was used to evaluate the bacterial resistance to cefotaxime, meropenem, gentamicin, amikacin, ciprofloxacin, ceftriaxone, nitrofurantoin and nalidixic acid. The resistant strains were also confirmed using a combination of cefotaxime-clavulanic acid and ceftazidime-clavulanic acid discs. The presence of CTX-M gene was evaluated among ESBL-producing strains by Real time PCR. SPSS 20 software and chi-square test were used to analyze data statistically. Results: A total of 84 E.coli isolates were detected in all specimens. The most sensitivities were against amikacin (91.67%), meropenem (96.43%), ampicillin/sulbactam (95.24%) and  piperacillin/tazobactam (94.5%). However, the highest resistancies were against nalidixic acid (83%) , doxycycline/ salicilin (70%), ceftriaxone (46.63 %) and ciprofloxacin (51.2%). Twenty-nine isolates (34.5%) produced ESBL. The CTX-M positive ESBL-producing E-coli was 69%. There was a significant relationship between the presence of CTX-M gene and ESBL (P-value = 0.03). Conclusion: In the present study, the presence of beta-lactamase-producing genes (CTX-M) in E.coli strains were markedly high. Therefore, the consumption of antibiotics should be controled and further phenotypic and genotypic studies on bacterial pathogens should be conducted

Assess the prevalence rate of Campylobacter genus and Campylobacter jejuni species in raw milk collected from the Amol City by Multiplex- Polymerase Chain Reaction

Background & Objective: Campylobacter can be transmitted through the raw milk. The purpose of this study was to determine the prevalence of Campylobacter genus and Campylobacter jejuni (C. jejuni) species in raw milk samples. Materials & Methods: In this study, 72 samples of raw milk were collected of the platforms milk in the Amol city in summer. Phenotypic identification of Campylobacter genus and C. jejuni species using microbiology laboratory methods and molecular identification of this bacterium using Multiplex- Polymerase Chain Reaction (M-PCR) were performed. The data was calculated using the SPSS 16.0 software and the Fisher's&nbsp;exact&nbsp;test (p < 0.05). Results: Among the 72 samples, 13.88% of samples were contaminated with C. jejuni and 2.77% were contaminated with Campylobacter genus. The highest prevalence rate for this bacterium was in July (20.83%) and the lowest prevalence rate was in September (12.5%). The significant difference between the prevalence of the Campylobacter genus and C. jejuni species in raw milk samples in various months of summer was not observed (p = 0.07). Conclusion: This study showed the raw milk contamination with Campylobacter, and thereby the sanitation in the dairy food production places and the use of fast and accurate method to identify this bacterium is important

Evaluation of anti-tumor potential of lactobacillus acidophilus atcc4356 culture supernatants in mcf-7 breast cancer

Background: The anti-cancer activity of some lactic acid bacterial strains is well documented in several kinds of literatures. Lactobacillus strains have received considerable attention as a beneficial microbiota. The aim of this study is to evaluate the effects of anti-tumor activities of L. acidophilus ATCC4356 culture supernatants on the MCF-7 human breast cancer cells. Materials and Methods: The anti-cancer effects of 24h and 48h culture supernatants at various concentrations (1.25, 2.5, 5, 10 and 20 µg/ml) were determined by various in vitro and in vivo assays including MTT, tumor volume measurement as well as99mTc-MIBI biodistribution in MCF-7 tumor bearing nude mice and histopathology test. For evaluation of the related mechanism of action, quantitative PCR was conducted. Results: The 48h culture supernatants at 10 and 20 µg/ml exhibited significant in vitro inhibition of MCF-7 cell proliferation. However, this inhibition was not observed for HUVEC human endothelial normal cells. Q-PCR indicated that treatment by the supernatant led to a significant downregulation of VEGFR (~ 0.009 fold) and Bcl-2 (~ 0.5 fold) and upregulation of p53 (~ 1.3 fold). In vivo study using MCF-7 xenograft mouse models demonstrated a reduction in tumor weight and volume by both 24h and 48h supernatants (2 mg/kg) after 15 days. According to the99mTc-MIBI biodistribution result, treatment of MCF-7 bearing nude mice with both 24h and 48h supernatant (2mg/kg) led to a significant decrease in tumor uptake compared with the control group. Conclusion: These results suggest that the culture supernatants of L. acidophilus ATCC4356 at suitable concentrations can be considered as a good alternative nutraceutical with promising therapeutic indexes for breast cancer

Synergistic antibacterial effects of methanolic extract of Melissa officinalis L. and Mouthwash Vi-one on Streptococcus mutant and Streptococcus sanguinis

Introduction: The use of chemical and vegetable compounds reduces the microbial plaque of the tooth. The aim of this study was to investigate the synergistic antibacterial effects of methanolic extract of Melissa officinalis L. (Lemon balm) and mouthwash Vi-one on Streptococcus mutant and Streptococcus sanguinis. Methods: Methanolic extract of lemon balm was prepared by Soxhlet method. The concentrations of 250, 125, 62.5, 31.25, 15.26, 7.81, 3.9, 1.95, 0.97 and 0.48 mg/ml of methanol extract and mouthwash prepared and mixed in the same proportion. Agar well diffusion, minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) were used to determine the antibacterial effect. Results: The highest non-growth zones were 21 mm for Streptococcus mutant and 22 mm for Streptococcus sanguinis which observed at a concentration of 250 mg/ml. The best value of MIC and the MBC for both bacteria were 7.81 and 62.5 mg/ml, respectively. As the concentration increased, antibacterial activity increased as well (P ≤ 0.05). Conclusion: The results of this study showed the synergistic antibacterial effects of lemon balm and mouthwash on bacteria. More in vivo researches are needed to confirm and use the above combination

Antibiotic resistance pattern and assessment of Temorina gene in clinical strains of extendedspectrum beta-lactamase enzyme producing Escherichia coli isolated from patients, Babol City, Mazandaran Province

Introduction: Escherichia coli (E. coli) bacteria are a common cause of various clinical infections. Resistance of this bacteria to several common antibiotics due to production of extended spectrum betalactamase (ESBL) enzyme has caused therapeutic problems. The aim of this study was to determine the resistance pattern to beta-lactam antibiotics and also to assess the Temorina (TEM) gen in the E. coli strains isolated from the patients in Babol, Iran. Methods: This cross-sectional study was conducted in 2014 at Babol County, Iran. The E. coli strains were isolated and identified by standard laboratory tests. The sensitivity test to beta-lactam antibiotics was performed by combined disk method. The TEM gene was identified in the resistant strains by the polymerase chain reaction (PCR) method. The data were analyzed by SPSS 20 and by using T-test and Chi-squared tests. Results: Of the 10,341 clinical samples, 525 E. coli isolated of which 200 (38%) were ESBL-producing strains. Piperacillin-tazobactam, amikacin, ampicillin-sulbactam and ampicillin (98%, 90.33%, 86.4% and 76.60%, respectively) had the most inhibition effect on the strains. Highest antibiotic resistance was observed for ceftriaxone (43.80%) and ciprofloxacin (38.74%). PCR showed that 80% (n=160) of the resistant strains had the TEM gene. There was a significant correlation between TEM gene and the production of ESBL (P < 0.05). Conclusion: Resistance to antibiotics was observed in this study. Resistant and ESBL-producing strains of E. coli had TEM gene. The clinicians should be aware of antibiotic resistant pattern to choose effective medicines for treatment of these infections. Keywords: Escherichia coli Antibiotic resistance pattern Extended-spectrum beta-lactamase Temorin

Association between COVID-19 Infection and ABO Blood Types in Mazandaran Province, Iran: A Cross-Sectional Study

Background and purpose: The association between ABO blood types and Coronavirus disease 2019 (COVID-19) have been investigated in several studies but there are inconsistencies in results. The purpose of this study was to investigate the association between ABO blood types and COVID-19 infection based on serologic results. Materials and methods: A cross-sectional seroepidemiologic study was carried out in 1504 people living in Mazandaran province, north of Iran. Blood samples were drawn to determine blood groups. Also, IgG and IgM antibodies were measured by ELISA. Data analysis was done using Chi-square, Fisher’s exact test, univariate and multivariate logistic regression analyses in SPSS V25. Results: The frequency of IgG positive among blood groups A, B, AB, and O was 12.7%, 11.8%, 9.4%, and 9.6%, respectively. After adjusting for suspicious confounding factors, the odds ratio of COVID-19 infection was 1.19 (95% CI:0.85-1.67) in blood group A, 1.33 (95% CI:0.94-1.87) in blood group B, 0.82 (95% CI:0.44-1.55) in blood group AB, and 0.70 (CI 95%:0.50-0.98) in blood group O based on serologic results (IgG+/IgM+). Conclusion: The odds ratio for COVID-19 was significantly lower (30%) in blood group O compared to other blood groups, so blood group O can be considered as a protective factor against COVID-19